Application for Schengen Visa - MVA International

1 Application for Schengen visa This Application form is free EMBASSY OF ITALY MANAMA KINGDOM OF BAHRAIN photo 1. SURNAME(S) / FAMILY NAME(S) FOR OFFICIAL USE ONLY Date of Application : .. visa Application number: .. Il ricevente : Ambasciata Service provider -------------------------------------- Pagamento -------------------------------------- Doc. a supporto: Passaporto valido Mezzi economici Prenotazione aerea Ass. sanitaria Altro Invit o da.

2 Domanda: Accettata / Rifiutata Tipologia visto: Per: ITALIA / MALTA Frontiera ingresso: Destinazione: Tipo di visto: A C C1 C2 C3 C5 D Altro: .. Numero di ingressi 1 2 Multi Valido per gg.. DAL : .. AL .. ------------------------------- PASSPORT COLLECTED BY 2. SURNAME(S) AT BIRTH (earlier family names) 3. NAME (given name) 4. DATE OF BIRTH (day / month / year) 5. ID-number 6.

3 PLACE OF BIRTH 7. COUNTRY OF BIRTH 7. CURRENT NATIONALITY/IES 8. ORIGINAL NATIONALITY (nationality at birth) 9. SEX Male Female 10. MARITAL STATUS: Single Married Separated Divorced Widow(er) Other 11. FATHER S SURNAME NAME 12. MOTHER S SURNAME NAME 13. TYPE OF PASSPORT National passport Diplomatic passport Service passport Travel document (1951 Convention) Alien s passport Seaman s passport Other travel document (please specify): 14.

4 PASSPORT S NUMBER 15. ISSUED BY 16. DATE OF ISSUE 17. VALID UNTIL 18. IF YOU RESIDE IN A COUNTRY OTHER THAN YOUR COUNTRY OF ORIGIN, HAVE YOU PERMISSION TO RETURN TO THAT COUNTRY? NO YES (number and validity): .. *19. OCCUPATION / PROFESSION *20. COMPANY S NAME, ADDRESS, TELEPHONE NUMBERS - FOR STUDENTS : SCHOOL S NAME AND ADDRESS 21. MAIN DESTINATION 22. TYPE OF visa Airport transit Transit Short stay Long stay 23. visa Individual Collective 24.

5 NUMBER OF ENTRIES REQUESTED Single entry Multiple entries 25. DURATION OF STAY visa is requested for : .. days 26. OTHER VISAS (issued during the past three years) AND THEIR PERIOD OF VALIDITY 27. IN THE CASE OF TRANSIT, HAVE YOU AN ENTRY PERMIT FOR THE FINAL COUNTRY OF DESTINATION? NO YES, valid until: .. Issuing authority:.. *28. PREVIOUS STAYS IN THIS OR OTHER Schengen STATES 29. PURPOSE OF TRAVEL Tourism Business Visit to Family or Friends Cultural/Sports Official Medical reasons Other (please specify).

6 30. DATE OF ARRIVAL IN Schengen 31. DATE OF DEPARTURE FROM Schengen 32. BORDER OF FIRST ENTRY OR TRANSIT ROUTE 33. MEANS OF TRANSPORT *34. HOST S NAME (company or other) in the Schengen state - If not applicable, name of hotel address in the Schengen state. Name: Telephone: Full address: Fax: e- mail address: * 35.

7 WHO IS PAYING FOR YOUR COST OF TRAVELLING AND FOR YOUR COSTS OF LIVING DURING YOUR STAY? Myself Host person/s Host company * 36. MEANS OF SUPPORT DURING YOUR STAY Cash Travellers' cheques Credit cards Accommodation Other : 37. TRAVEL AND/OR HEALTH INSURANCE VALID UNTIL: 38. SPOUSE S FAMILY NAME 39. SPOUSE S FAMILY NAME AT BIRTH 40. SPOUSE S FIRST NAME 41. SPOUSE S DATE OF BIRTH 42.

8 SPOUSE S PLACE OF BIRTH 43. CHILDREN ( applications must be submitted separately for each passport) SURNAME FIRST NAME DATE OF BIRTH PLACE OF BIRTH 1. 2. 3. 44. PERSONAL DATA OF THE EU OR EEA CITIZEN YOU DEPEND ON This question should be answered only by family members of EU or EEA citizens. SURNAME FIRST NAME DATE OF BIRTH NATIONALITY PASSPORT NO.

9 FAMILY RELATION TO AN EU OR EEA CITIZEN 45. I am aware that the visa fee is not refunded if the visa is refused 46. Applicable in case a multiple-entry visa is applied for (cf. field No. 24): I am aware of the need to have an adequate travel medical insurance for my first stay and subsequent visits to the territory of Member States. 47. I am aware of and consent to the following: any personal data concerning me which appear on this visa Application form will be supplied to the relevant authorities in the Schengen states and processed by those authorities, if necessary, for the purposes of a decision on my visa Application .

10 Such data may be input into, and stored in, databases accessible to the relevant authorities in the various Schengen states. At my express request, the consular authority processing my Application will inform me of the manner in which I may exercise my right to check the personal data concerning me and have them altered or deleted, in particular, should they be inaccurate, in accordance with the national law of the state concerned. I declare that to the best of my knowledge all particulars supplied by me are correct and complete.